Aortic valve preservation in acute type A dissection: is it sound?

The Journal of Thoracic and Cardiovascular Surgery
L K von SegesserM Turina

Abstract

A series of 200 consecutive patients with acute Stanford type A dissection (157 men, 78%; 43 women, 22%) was analyzed to assess the validity of aortic valve preservation or repair. Indication for the operation in most cases was based on echocardiographic examination alone, to reduce the delay. In the majority of patients (111/200, 56%) the aortic valve was preserved or repaired if necessary. Aortic root replacement with a composite graft was performed in 66 of 200 patients (33%), mainly because of an enlarged aortic anulus and sinus. Replacement of the aortic valve and the supracoronary ascending aorta was performed in 23 of 200 patients (12%) with a diseased aortic valve (e.g., bicuspid valve) but an acceptable aortic sinus. Follow-up totaled 656 patient-years (maximum 14 years). Actuarial analyses as a function of type of repair and type of aortic valve provided the following probabilities plus or minus errors (95%): overall survival of the 200 patients was 78.3% +/- 2.9% after 30 days, 74.95% +/- 3.1% after 1 year, 67.9% +/- 3.6% after 5 years, and 48.5% +/- 6.1% after 10 years. Actuarial probability of freedom from reoperation for valve failure in the complete series was calculated as 100.0% +/- 0.0% after 30 days, 99.3% +/...Continue Reading

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